Zoonotic infection and clonal dissemination of Streptococcus equi subspecies zooepidemicus sequence type 194 isolated from humans in Thailand.

Streptococcus equi subsp. zooepidemicus (SEZ) is a zoonotic pathogen associated with diseases in a wide range of animals as well as in humans. SEZ sequence type (ST) 194 strains have been associated with outbreaks in China, the USA, and Canada and have caused high mortality in pigs. Nevertheless, human infection by this ST has never been reported. This study conducted a retrospective analysis of 18 SEZ strains from human patients in Thailand during 2005-2020. The study revealed clonal dissemination of ST194 with the identical pulsotype in human patients throughout Thailand. Clinical manifestation was mainly septicemia (61.1%), while 72.2% had a history of eating raw pork products. There were six fatal cases (33.3%). Antimicrobial susceptibility testing revealed that all strains were susceptible to penicillin, ampicillin, cefotaxime, erythromycin, levofloxacin, clindamycin, chloramphenicol, tetracycline and vancomycin. Virulence-associated genes, including bifA, szM, szP, sdzD, spaZ, and fszF, were present in all tested strains. Some representative genes in four pathogenicity islands found in the swine outbreak SEZ-ATCC35246 (ST194) strain were detected in these SEZ strains. Whole-genome sequencing analysis of three representative SEZs in this study revealed no acquired antimicrobial-resistant genes and they contained the same virulence factors. The single-nucleotide polymorphism phylogenetic tree demonstrated that the current strains were clustered with swine ST194 strains. The results should be highlighted as a public health concern, especially to those who may directly or indirectly have contact with livestock or companion animals or have consumed raw meat products as risk factors for infections with SEZ.